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Risk of bias (RoB) was assessed using the Joanna Briggs Institute tools. Data on eye fixation metrics and subjective ratings were descriptively synthesized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 7009 studies, 27 met inclusion criteria (11 high, 10 moderate, and 6 low RoB) with variable methodologies. Ethnic and cultural factors were rarely considered. The eyes received the most attention in facial aesthetics. However, severe malocclusion and orthodontic appliances redirected gaze to the mouth, while attractive facial features mitigated this effect. Laypeople were more tolerant of malocclusion than dental professionals, who were more sensitive to malocclusion deviations. Facial esthetic perception revealed gender-related differences, where females focusing more on the eyes and males on the mouth and nose.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Malocclusion and orthodontic appliances affect esthetic perception by altering gaze patterns. Integrating eye-tracking technology into orthodontic practice can improve patient satisfaction by aligning treatments with esthetic expectations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09287329251356163","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T08:40:21Z","timestamp":1752223221000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Objective assessment of the influence of malocclusion and orthodontic devices on facial and smile esthetics in laypeople via eye-tracking technology: A systematic review of clinical studies"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1180-7753","authenticated-orcid":false,"given":"Nabeel","family":"Almotairy","sequence":"first","affiliation":[{"name":"Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraidah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdalaziz F","family":"Alsuliman","sequence":"additional","affiliation":[{"name":"College of Dentistry, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nawaf A","family":"Alfawaz","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Pediatric Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2019.08.015"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1708-8240.1999.tb00414.x"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1073-8746(98)80016-9"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1590\/2177-6709.21.6.051-057.oar"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajodo.2013.02.013"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1590\/2177-6709.25.1.056-063.oar"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.2319\/020121-95.1"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9416(85)90170-8"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/17.6.505"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejo\/cjq014"},{"key":"e_1_3_4_12_2","first-page":"221","article-title":"Smile analysis and design in the digital era","volume":"36","author":"Ackerman MB","year":"2002","unstructured":"Ackerman MB, Ackerman JL. 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